Risks & Complications

As with any surgery, breast augmentation involves some risks and potential complications. These are listed below and are separated into general risks which can occur with any surgical procedure, and risks specific to the breast augmentation operation.

Generally speaking any surgical procedure can be accompanied by the following three conditions:

1. Infection

Infection is a significant risk in that the presence of a foreign body (i.e. the breast implant) can cause prolongation of the infection. Infection is rare, but should it occur, it may be necessary for the prosthesis to be removed temporarily (up to about six weeks) until the infection is controlled. Once the implant is replaced however, the result should be indistinguishable from the opposite normal side.

Special precautions are taken to limit the chances of infection and these include showering prior to surgery with antiseptic soap, intravenous antibiotics during the operation and a course of antibiotics following surgery. If pain and redness begins or increases after 24 – 48 hours this may indicate an infection and this should be immediatelyreported to your surgeon.

2. Bleeding and Hematoma Formation

Excessive post-operative bleeding can be caused by a variety of factors. One of these is the taking of blood thinning medications such as aspirin and we can give you a list of drugs that can cause this problem. You should not take such medications for at least 10 days prior to your operation.

Some bleeding occurs after all surgery – it is natural. But excessive bleeding and hematoma formation are a problem. To deal with this, your chest will be bound firmly for 24 hours after surgery and a small drain will be inserted into each side. The drains remain in place until they stop draining. They are an important indicator of what is going on inside your chest.

It is our experience that if bleeding does occur and a hematoma develops it can lead to abnormal thickening of the scar capsule around the implant (capsular contracture) or to an increased possibility of infection. It is therefore appropriate that if bleeding does occur in the first 24 to 48 hours that the patient is returned to the operating room with removal of the implant and cleaning out of the abnormal blood which has accumulated. The implant is replaced immediately after the bleeding has been controlled and this usually results in no further problems. If excessive bleeding does occur, increasing pain will be experienced and the breast on that side will be abnormally swollen compared to the opposite side. This is always in the early post-operative stage and should be reported immediately to your surgeon

3. Scarring

A sequel of any surgical procedure is scarring. Each and every time the skin is cut either by scalpel or laser, a surgical scar is produced. The quality and appearance of scars vary widely with the individual’s healing process, the position of the scar on the body and degree of tension placed on the scar. The types of scars a patient acquires are influenced by personal, familial and racial factors and cannot be controlled by your surgeon.

The incisions for the insertion of the breast implants can be placed under the arm, around the nipple or in the crease under the breast. All incisions will leave a scar no matter how faint.

The scar in the axilla (underarm) is well hidden when the arms are by the side or even at reasonable elevation. However, if the arm is lifted completely above the head during the early stages of healing a red scar may be seen. This can persist for up to six months. When the scar eventually settles it usually looks like a crease in the skin. This area can on occasion be prone to scar thickening. However, this is rare.

The scar around the nipple is, of course, not seen while the patient is clothed. However when the nipple is exposed the scar is sometimes seen as a white line on the lower border of the areola. The visibility of the scar depends on the colour of the areolar skin. Scars are always white, so the darker the areolar skin, the more obvious the white scar. Thickening of the scar in the area of the areola is extremely rare, but can occur.

The scar in the crease of the breast is usually not seen when the patient is standing. However, when you lie down the scar is easily seen. While the scar is red (in the first 3-6 months) it can be quite noticeable. Scars in this position have a higher chance of thickening (hypertrophy) and on occasions can become quite thick (keloid) and take several years to settle. The scar in the crease under the breast is not actually in the crease but slightly above the crease on the under surface of the breast.

The indications for using various incisions and the quality of the scar will be further explained to you by your surgeon.

Scarring also occurs in the deeper layers of skin and muscle. This is more frequent when the skin and other layers have been separated and these deep scars can behave in the same way as skin scars, becoming thick, lumpy, raised and tender. As with skin scars, this type of scarring will settle and mature with time, but the process may take many months. The most noticeable areas where this deeper type of scarring can occur are the cheeks of face lifts and liposuction. Massage and other types of treatment can help with maturing and flattening the scar, but time is always necessary.

Specific Risks

Capsular Contracture

Any foreign implant that is inserted into the body is ultimately surrounded by a scar formed by the body to wall it off from the other tissues. This occurs also with the breast prosthesis. All scars shrink or contract to a certain degree. If this occurs to excess in the breast, the shape of the implant may distort. It usually becomes round or globular. The breast may also feel hard to varying degrees.

This hardening, caused by excessive contracture of the normal scarring phenomenon, can occur in between 5 and 35% of breast augmentation operations and can be influenced by the surgical technique as well as the type of implant used.

Recently, rough surfaced implants have been noted to have a lower incidence of scar contracture, but there are other trade-offs as a result of using the rough surfaced implant. These include a wavy appearance of the skin around the margin of the implant and fuller projection of the implant. A smooth implant inserted into a large space will also have a low incidence of scar contracture, but it is necessary after the operation to manipulate the implant to maintain a large pocket and therefore a large scar surrounding the implant. If capsular contracture does occur, it can be accompanied by discomfort or pain and this may necessitate further operative treatment to release or remove the internal scar. If it is not causing problems then no further treatment may be necessary. The position of the incision usually has no bearing on the chance of scar contracture.

Loss of Nipple Sensation

This operation may be accompanied by an alteration of nipple sensation. Nipple sensation can be increased as well as decreased after surgery, but over a period of months the number of patients with permanent alteration of nipple sensation decreases to approximately 10%. This seems not to depend on the site of the incision that is used, but is mainly due to stretching or damage of the nerve at the outer part of the breast while the cavity is being made. There can also be a temporary loss of feeling of the breast skin particularly in the area beneath the nipple. It is usually found that this sensation returns over a six month period. Our experience is that nipple sensation is unaffected in 70% of patients. For 10%, sensation is enhanced. In 20% however, nipple sensation may be diminished or even rendered numb. Permanent numbness is however quite uncommon.

Implant Deflation

The manufacturers of saline implants advise that there is a failure rate of the implant with subsequent deflation in the order of approximately 5% over 10 years. Although clinical experience to date has not confirmed a failure rate of this magnitude, the manufacturers have obviously taken a cautious line. It is unreasonable to expect that any mechanical device may not fail sometime. Breast implants are no exception. If the implant should fail either by valve failure or “cracking” of the wall of the prosthesis, the breast would deflate and the salty water would be absorbed into the body. Saline is not detrimental in any way to the patient. It is similar to the intravenous fluid given at operations and is eliminated from the body in the urine.

The deflated implant would have to be replaced and this would require a further small procedure, re-opening the same incision line. In advising of this complication, the manufacturers warn patients that breast augmentation with saline filled devices should not be regarded as a final or permanent procedure.

Asymmetry, Firmness and Discomfort

These complications are usually a result of asymmetrical or excessive contracture of the scar or capsule which forms around the prosthesis internally. The formation of the scar capsule is a normal biological response to the implantation of foreign material and excessive contracture can distort the shape of the breast. This can be in the order of 5-35% depending on the type of implant and procedure used

Minor Displacements or Asymmetry

Minor displacements leading to asymmetry of the implants are generally not different from the variations of the breasts considered to be within normal limits. Quite frequently, minor asymmetries or even significant asymmetries of the breasts can be seen prior to surgery and your surgeon will frequently make a note of these.

You can return to your activities at a slow, gradual pace. You may be back to work as soon as five to seven days after surgery and may begin light exercise in a week or so.

Lifting and strenuous moving may be restricted for several weeks or longer. Follow the golden rule – “If it hurts, don’t do it”.

  • Australian Society of Plastic Surgeons
  • American Society Plastic Surgeons
  • Allergan
  • MENTOR Make Life more beautiful
  • ROYAL Australian College Of Surgeons